Quick Answer: What Is A Level 2 Modifier?

What is the difference between Level 1 and Level 2 Hcpcs codes?

HCPCS includes three separate levels of codes: Level I codes consist of the AMA’s CPT codes and is numeric.

Level II codes are the HCPCS alphanumeric code set and primarily include non-physician products, supplies, and procedures not included in CPT..

What is modifier 57 used for?

Modifier 57 Decision for Surgery: add Modifier 57 to the appropriate level of E/M service provided on the day before or day of surgery, in which the initial decision is made to perform major surgery. Major surgery includes all surgical procedures assigned a 90-day global surgery period.

What are Hcpcs Level II modifiers used for?

Many HCPCS Level II modifiers are used to communicate information about the service or supply provided and not necessarily to impact reimbursement for the CPT or HCPCS procedure code to which it is appended.

What is the KX modifier?

Modifier KX Use of the KX modifier indicates that the supplier has ensured coverage criteria for the billed is met and that documentation does exist to support the medical necessity of item.

What is the difference between CPT code 99212 and 99213?

CPT Code 99212 is a level two code. … For CPT Code 992213, an outpatient or inpatient office visit that is considered to be a mid-level visit can be billed with this code. CPT Code 99213 can only be used for an already established patient. It is a level 3 code.

What is the 26 modifier?

The CPT modifier 26 is used to indicate the professional component of the service being billed was “interpretation only,” and it is most commonly submitted with diagnostic tests, including radiological procedures. When using the 26 modifier, you must enter it in the first modifier field on your claim.

What is a 58 modifier used for?

Staged or related procedure or service by the same physician during the postoperative period. Submit CPT modifier 58 to indicate that the performance of a procedure or service during the postoperative period was either: Planned prospectively at the time of the original procedure (staged);

What is the 76 modifier used for?

Modifier 76 is used to report a repeat procedure or service by the same physician and is appended to the procedure to report: Repeat procedures performed on the same day. Indicate that a procedure or service was repeated subsequent to the original procedure or service.

What are Level 1 modifiers?

CPT modifiers (also referred to as Level I modifiers) are used to supplement information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition.

What are the three categories of CPT codes?

Types of code There are three types of CPT code: Category I, Category II, and Category III.

What is a GX modifier?

Modifier GX The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.

What is a Level 2 CPT code?

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office.

What is a 59 modifier?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. … Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

What is a Level 2 visit?

Level 2 Established Office Visit (99212) This is the second lowest level of care for an established patient being seen in the office. Internists used this code for 3.1% of these encounters in 2014. Usually the presenting problems are self-limited or minor.

What is a UB modifier?

Modifier Description UB Medically necessary delivery prior to 39 weeks of gestation. UC Delivery at 39 weeks of gestation or later.